CERTIFICATE OF CLOSURE
Emergency Closures Reporting
2008 - 2009
(1st period, 2nd period or 3rd period)
District # District Name
In compliance with I.C. 33-1003A, certify the cause and duration of each incident of emergency school closure.
For each emergency closure, show the number of instructional hours missed for each grade grouping.
If the missed instructional hours in each grade grouping for all buildings in the district where the same, then fill one line listing "All".
If the emergency closure was for 2 or more consecutive full days, show on one line the date(s) of the closure.
Report instructional hours to 2 decimal place.
Attach a copy of the school board minutes showing approval for each emergency closure stating the cause and duration.
Amount of Amount of Amount of Amount of
Cause for the Kindergarten Grades 1-3 Grades 4-6 Grades 7-12
or if Date(s)
Emergency Closure Instructional Instructional Instructional Instructional
District Wide All
Hours Missed* Hours Missed* Hours Missed* Hours Missed*
I certify that this information is accurate. If requested,
I will provide the detail to document the reported information.
Please submit with the Attendance and Enrollment Reports.
*Be sure to reduce your instructional hours on your school calendars to reflect the closure.